Failure to Thrive (FTT)
What to do if your baby is not gaining enough weight.
This problem can otherwise be termed as failure to thrive (FTT) and can be a sign of poor health, requiring immediate intervention as it can in the very worst case scenario, result in serious problems such as a decrease in physical growth, lack of cognitive development and ultimately death if not treated appropriately and timely.
Causes of FTT
Inadequate energy intake from too little breastmilk, possibly due to an inability by baby to suck properly, or because feeds are too regimented by mum and baby is not allowed to demand their individual requirements thus resulting in too little breastmilk intake
Poor absorption or nutrients for some reason
Increased metabolic demands.
How is FTT confirmed?
In a newborn (the first few weeks) nearly all babies reduce their weight to some degree. The definition of FTT is a loss that is 10% of birthweight or more, or a baby that has not regained their birthweight by the time they are 2 weeks old. Plotting weight on a baby growth chart is essential in order to monitor progress and so that FTT can be assessed in any meaningful way as follows:
Baby should weigh greater than 80% of ideal body weight for their age
Baby’s weight or height for age should not be less than the 3rd or 5th percentile
Baby’s weight should not fall through 2 percentile curves on their growth chart
A thorough assessment of baby’s health must be made, to determine whether the baby is suffering from lack of nutrition or lack of nutrition due to ill health.
A diagnosis can be made by a midwife, GP or lactation consultant, however it is important that a paediatrician is made aware of the diagnosis and is in agreement with any care plan to be implemented plan.
In particular mum and / or dad will be asked about the following:
Is baby well – is there any fever, or prolonged jaundice?
Does baby seem happy to be cuddled and fed or does he cry excessively – how does it sound?
Feeding pattern – is mum fitting baby around her routine or vice versa?
Baby’s latch – is it correct, is there tongue tie?
If breastmilk supply is low whether mum is pumping to try and achieve greater milk supply
Has a galactagogue (a drug to enhance milk production) been taken?
Can mum assess her baby’s feeding cues adequately?
Is mum noting baby’s output on a daily basis – wet and dirty nappies
How baby behaves before, during and after a feed – do they demand a feed, so they suck with vigour, are they satisfied after a feed?
Is baby having any supplemental formula milk and how much – or vitamins
Is mum happy and enjoying motherhood, is her home environment suitable for a newborn?
Baby may require admission to hospital if he is considered to be greatly at risk or unwell and requiring treatment.
Tongue-tie may need to be managed with a minor surgical procedure to improve suck technique
A plan to introduce supplemental formula or donor breastmilk feeds will be advised which will complement your own breastmilk, ensuring baby is having a required intake for adequate nourishment and growth. This can be given by bottle, cup or tube depending on your preference.
Baby will be weighed regularly preferably on the same set of scales and output monitored.
You will be given lots of emotional support from your carers and hopefully be able to resume full breastfeeding in time.